China Rural Hypertension Control Project

NCT ID: NCT03527719

Last Updated: 2025-12-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

33995 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-05-08

Study Completion Date

2026-12-31

Brief Summary

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China Rural Hypertension Control (CRHC) Project is a cluster randomized trial that will test the effectiveness of a village doctor-led multifaceted intensive blood pressure intervention on hypertension control in 18 months (Phase 1), cardiovascular disease risk in 36 months (Phase 2), and all-cause dementia in 48 months (Phase 3) among patients with hypertension in rural China. An extended observational follow-up, the CRHCP post-intervention observational follow-up study, will be conducted at Year 7 to evaluate long-term effects.

Detailed Description

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The overall objective of the CRHC Project is to develop an effective, adoptable, and sustainable implementation strategy to achieve more intensive blood pressure (BP) control among rural residents in China. Moreover, this effectiveness-implementation trial will test the effectiveness of a lower BP target (\<130/80 mmHg) on cardiovascular disease (CVD) and all-cause dementia. Specifically, we will test the effectiveness of a village doctor-led multifaceted intervention, compared with usual care, on BP control, CVD, and dementia among rural residents with hypertension in China. This cluster randomized trial is conducted in 326 villages from three provinces in mainland China. A total of 163 villages was randomly assigned to a village doctor-led multifaceted intervention and 163 villages to usual care, stratified by provinces, counties, and townships. A total of 33,995 individuals aged ≥40 years with uncontrolled hypertension were recruited into the study. The village doctor-led multifaceted intervention is designed to overcome barriers at the healthcare system, provider, patient, and community levels. Study participants are followed every 6 months for BP, CVD, and other study outcomes. The primary outcome is BP control (\<130/80 mm Hg) at 18 months in phase 1, CVD events over 36 months in phase 2, and all-cause dementia at 48 months in phase 3. In addition, an extended observational follow-up will be conducted at Year 7 without further active intervention, to evaluate long-term outcomes including major cardiovascular events, dementia or cognitive outcomes, all-cause mortality, renal outcomes, and the sustainability of implementation fidelity.

Conditions

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Hypertension

Keywords

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Hypertension Cardiovascular disease Dementia China Protocol-based treatment Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
Outcome Assessment Committee members will be blinded to outcome assignment.

Study Groups

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Experimental Group

Village-doctor-led multifaceted intervention

Group Type EXPERIMENTAL

Village-doctor-led multifaceted intervention

Intervention Type OTHER

* Establishing a network including hypertension specialists at city/county hospitals, primary care physicians at township hospitals, and village doctors to collaboratively manage hypertension
* Using hypertension control rate as one of the metrics for incentive supplements to village doctors
* Providing discounted or free antihypertensive medications to patients with hypertension
* Training village doctors to measure blood pressure according to a standard protocol
* Training village doctors to use a simple stepwise protocol for hypertension treatment
* Training village doctors to conduct health coaching on lifestyle change (e.g., lowering sodium and alcohol intake) and medication adherence
* Providing free blood-pressure monitor and training to patients for home blood pressure measurement
* Encouraging lifestyle change and medication adherence
* Connecting patients through WeChat or telephone for group social support

Control Group

Village doctors in usual care group will not receive hypertension management training or support. However, they will be trained in standardized BP measurement. Participants in control group will receive their usual care from village doctors or primary care physicians in township hospitals

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Village-doctor-led multifaceted intervention

* Establishing a network including hypertension specialists at city/county hospitals, primary care physicians at township hospitals, and village doctors to collaboratively manage hypertension
* Using hypertension control rate as one of the metrics for incentive supplements to village doctors
* Providing discounted or free antihypertensive medications to patients with hypertension
* Training village doctors to measure blood pressure according to a standard protocol
* Training village doctors to use a simple stepwise protocol for hypertension treatment
* Training village doctors to conduct health coaching on lifestyle change (e.g., lowering sodium and alcohol intake) and medication adherence
* Providing free blood-pressure monitor and training to patients for home blood pressure measurement
* Encouraging lifestyle change and medication adherence
* Connecting patients through WeChat or telephone for group social support

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

Eligibility criteria for study villages:

* The village has a regular village doctor who is willing to participate in the hypertension control project
* The village does not plan to merge with other villages within 3 years
* The village is at least 2 kilometers away from other participating villages
* The village participates in the China New Rural Cooperative Medical Scheme

Eligibility criteria of study participants:

* Men or women aged ≥40 years
* Mean untreated systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg or mean treated systolic BP ≥130 mm Hg and/or diastolic BP ≥80 mm Hg for individuals without a history of clinical CVD; or mean treated/untreated systolic BP ≥130 mm Hg and/or diastolic BP ≥80 mm Hg for individuals with a history of clinical coronary heart disease, heart failure, stroke, diabetes, or chronic kidney disease
* Have lived in a participating village for at least 6 months
* No intention to migrate within next 3 years
* Taking part in the New Rural Cooperative Medical Scheme
* Not pregnant or planning to become pregnant
* No malignant tumors and life expectancy ≥3 years
* Willing to participate and able to sign informed consent
Minimum Eligible Age

40 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Tulane University

OTHER

Sponsor Role collaborator

First Affiliated Hospital Xi'an Jiaotong University

OTHER

Sponsor Role collaborator

Tongji Hospital

OTHER

Sponsor Role collaborator

Disease Control and Prevention Centre of Liaoning Province

UNKNOWN

Sponsor Role collaborator

Chaoyang Central Hospital

OTHER

Sponsor Role collaborator

Hanzhong People's Hospital

UNKNOWN

Sponsor Role collaborator

Disease Control and Prevention Centre of Chaoyang City

UNKNOWN

Sponsor Role collaborator

Shengjing Hospital

OTHER

Sponsor Role collaborator

First Hospital of China Medical University

OTHER

Sponsor Role lead

Responsible Party

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Yingxian Sun

Chief of Department of Cardiology in First Hospital of China Medical University

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Yingxian Sun, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

First Hospital of China Medical University

Locations

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The First Hospital of China Medical University

Shenyang, Liaoning, China

Site Status

Countries

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China

References

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Sun G, Ye N, Wang C, Liu S, Miao W, Qiao L, Ouyang N, Geng D, Shi C, Zhang L, Zhang P, Yin Y, Xie Z, Yu Y, Sun Y. Evaluating intensive blood pressure control versus usual care on cardiovascular disease in patients with diabetes using win statistics: a subgroup analysis of a cluster randomized trial. J Adv Res. 2025 Sep 29:S2090-1232(25)00758-1. doi: 10.1016/j.jare.2025.09.054. Online ahead of print.

Reference Type DERIVED
PMID: 41033581 (View on PubMed)

Lu X, Wang J, Chen S, Lv L, Yu J. Effect of Comprehensive Health Management on Medication Adherence and Healthy Lifestyle Behavior of Patients With Hypertension. Int J Hypertens. 2025 Jul 19;2025:1165809. doi: 10.1155/ijhy/1165809. eCollection 2025.

Reference Type DERIVED
PMID: 41018530 (View on PubMed)

Sun G, Miao W, Liu S, Yin Y, Geng D, Ye N, Xie Z, Zhang L, Zhou S, Wang C, Qiao L, Pei S, Ouyang N, Shi C, Guo X, Sun Y. Intensive Systolic Blood Pressure Reduction and Kidney and Cardiovascular Outcomes: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2025 Jul 1;8(7):e2519604. doi: 10.1001/jamanetworkopen.2025.19604.

Reference Type DERIVED
PMID: 40643915 (View on PubMed)

He J, Zhao C, Zhong S, Ouyang N, Sun G, Qiao L, Yang R, Zhao C, Liu H, Teng W, Liu X, Wang C, Liu S, Chen CS, Williamson JD, Sun Y. Blood pressure reduction and all-cause dementia in people with uncontrolled hypertension: an open-label, blinded-endpoint, cluster-randomized trial. Nat Med. 2025 Jun;31(6):2054-2061. doi: 10.1038/s41591-025-03616-8. Epub 2025 Apr 21.

Reference Type DERIVED
PMID: 40258956 (View on PubMed)

Sun G, Guo X, Li G, Zhang P, Yin Y, Qiao L, Ye N, Wang C, Liu S, Geng D, Miao W, Xie Z, Yu Y, Li Z, Jiang X, Tan X, Sun Y. Intensive Blood Pressure Strategy on Cardiovascular Diseases in Patients With Metabolic Syndrome: Post Hoc Analysis of a Clinical Trial. J Am Heart Assoc. 2025 Mar 18;14(6):e036820. doi: 10.1161/JAHA.124.036820. Epub 2025 Mar 13.

Reference Type DERIVED
PMID: 40079319 (View on PubMed)

Sun G, Wang C, Ye N, Shi C, Ouyang N, Qiao L, Li G, Zhang L, Yu Y, Li Z, Zhou Y, Chen Z, Zhang S, Zhang P, Geng D, Miao W, Liu S, Sun Y. Impact of baseline cardiovascular risk on the outcomes of intensive blood pressure intervention: a post hoc analysis of the China rural hypertension control project. BMC Med. 2024 Jun 20;22(1):258. doi: 10.1186/s12916-024-03494-w.

Reference Type DERIVED
PMID: 38902731 (View on PubMed)

Guo X, Ouyang N, Sun G, Zhang N, Li Z, Zhang X, Li G, Wang C, Qiao L, Zhou Y, Chen Z, Shi C, Liu S, Miao W, Geng D, Zhang P, Sun Y; CRHCP Study Group. Multifaceted Intensive Blood Pressure Control Model in Older and Younger Individuals With Hypertension: A Randomized Clinical Trial. JAMA Cardiol. 2024 Sep 1;9(9):781-790. doi: 10.1001/jamacardio.2024.1449.

Reference Type DERIVED
PMID: 38888905 (View on PubMed)

He J, Ouyang N, Guo X, Sun G, Li Z, Mu J, Wang DW, Qiao L, Xing L, Ren G, Zhao C, Yang R, Yuan Z, Wang C, Shi C, Liu S, Miao W, Li G, Chen CS, Sun Y; CRHCP Study Group. Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention versus usual care on cardiovascular disease (CRHCP): an open-label, blinded-endpoint, cluster-randomised trial. Lancet. 2023 Mar 18;401(10380):928-938. doi: 10.1016/S0140-6736(22)02603-4. Epub 2023 Mar 2.

Reference Type DERIVED
PMID: 36871573 (View on PubMed)

Sun Y, Mu J, Wang DW, Ouyang N, Xing L, Guo X, Zhao C, Ren G, Ye N, Zhou Y, Wang J, Li Z, Sun G, Yang R, Chen CS, He J; CRHCP Study Group. A village doctor-led multifaceted intervention for blood pressure control in rural China: an open, cluster randomised trial. Lancet. 2022 May 21;399(10339):1964-1975. doi: 10.1016/S0140-6736(22)00325-7. Epub 2022 Apr 29.

Reference Type DERIVED
PMID: 35500594 (View on PubMed)

Sun Y, Li Z, Guo X, Zhou Y, Ouyang N, Xing L, Sun G, Mu J, Wang D, Zhao C, Wang J, Ye N, Zheng L, Chen S, Chang Y, Yang R, He J. Rationale and Design of a Cluster Randomized Trial of a Village Doctor-Led Intervention on Hypertension Control in China. Am J Hypertens. 2021 Aug 9;34(8):831-839. doi: 10.1093/ajh/hpab038.

Reference Type DERIVED
PMID: 33605981 (View on PubMed)

Other Identifiers

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KLS20181582

Identifier Type: -

Identifier Source: org_study_id